Hysterectomy

What is Hysterectomy?

Hysterectomy represents the surgical procedure that is used to remove the uterus. This procedure could also be used to remove the cervix, the ovaries, the Fallopian tubes or any other surrounding structures, such as tissue.

Hysterectomy could be total or partial. A total hysterectomy consists of removing the body, fundus and the cervix of the uterus, while the partial hysterectomy represents, actually, just the removal of the uterine body, without impacting the cervix. The total hysterectomy is also known as “complete”, while the partial hysterectomy is also known as “supracervical”.

It is very important to be aware to the fact that the removal of the uterus leads to infertility. The same happens after removing the ovaries or the Fallopian tubes. It is advised to take into consideration hysterectomy only if other treatment options are not available or they do not succeed.

In the United States of America, during the lifetime of a woman, there is a 45% risk of a woman needing a hysterectomy. Additionally, regarding women whose ages are at the reproductive stage, the hysterectomy represents the second most carried out surgical procedure, after the cesarean section. Fortunately, the incidence of hysterectomy is on a decline since the 1980s, when 7 out of 1.000 women were undergoing this procedure. Nowadays, as early diagnosis rates are improving as well as treatment options, 5 out of 1.000 women will have a hysterectomy. Moreover, the it looks like the women of color are at a higher risk of hysterectomy than white women and they also present a higher risk of complications related to the procedure.

Causes of Hysterectomy

There could be more reasons for which the medical specialist will consider that a hysterectomy is the best solution for his patient, as follows:

Fibroid tumors. Any non-malignant tumor can increase in dimension and become physically too large. The dimensions of the tumor could create pressure on other organs and they can also lead to heavy bleeding or pelvic pain. The uterine fibroids (uterine leiomyomas) are considered to be the most frequent cause for hysterectomy. One-third of all hysterectomies are performed on this condition’s account.
Endometriosis. Endometriosis occurs when the endometrial cells grow out of the uterus. These cells can attach to other organs from the pelvic cavity and could bleed monthly along with the ovarian cycle. Endometriosis could lead to chronic pelvic pain and heavy bleeding.
Endometrial hyperplasia. The endometrial hyperplasia consists in an over-thickening of the uterine lining. This is a result of constant existence of estrogen without progesterone. It is a condition that usually occurs in the perimenopause, as the levels of hormones are changing.
Cancer. Usually, in case of cancer, hysterectomy is performed only if the the cancer types that are treated with hysterectomy are cervical, ovarian, uterine or of the fallopian tubes.
The congestion of the bladder or of the intestines. Such blockage can occur on account of a uterus growth.

Ultimately, benign conditions like endometriosis, irregular bleeding and uterine fibroids are responsible for about 68% of the executed hysterectomies. The abnormal uterine bleedings are the second most frequent reason for hysterectomy. They represent the reason for about 16% of the hysterectomies.

As there are continuously developed new alternative treatments, hopefully, the incidence of hysterectomies for non-malignant conditions will decrease.

Types of Hysterectomy

Types of hysterectomy

This procedure is normally executed by a gynecologist.

Depending on the reasons for which a patient must undergo hysterectomy, the procedure could be different. Therefore, there are several types of hysterectomy:

Total hysterectomy. A total hysterectomy consists of removing both the womb and the cervix. Following this procedure, the patient will not have the possibility of developing cervical cancer after the surgery.
Subtotal hysterectomy. This kind of procedure is also known as partial hysterectomy, as the surgeon removes only the principal body of the womb. The cervix is not affected during this intervention. The subtotal hysterectomy is truly common. The disadvantage of this type of procedure is that cervical cancer can still develop. Therefore, regular cervical screening is mandatory after the surgery, as well.
Total hysterectomy with bilateral salpingo-oophorectomy. This type of hysterectomy includes the elimination of the fallopian tubes (salpingectomy) and of the ovaries (oophorectomy). It is recommended that the ovaries are not removed, specifically if there is the slightest possibility of further health problems, such as family history of ovarian cancer.
Radical hysterectomy. This type of procedure is performed only when cancer is not treated or cannot be treated with chemotherapy and radiotherapy. This type of hysterectomy involves the removal of the womb’s body and the cervix and the fallopian tubes, part of the vagina; fatty tissue; lymph glands or ovaries.

As there are more types of hysterectomy, there are also more techniques to perform a hysterectomy, as follows:

Laparoscopic hysterectomy is the most common way of removing the organs and the tissues of the reproductive system and it is performed under general anesthesia. The reasons for which this method is so used, is that the surgeon will insert a tube, that contains the laparoscope (it is very similar to telescope) along with a very delicate video camera, through the incision that he made. This special tube offers the possibility of visually checking the internal organs of the patient. Afterwards, the same tube will also be used for assistance in the process of removing the womb, cervix or other parts of the reproductive system that need to.
Abdominal hysterectomy is usually executed in order to extract the enlarged womb, pelvic tumors or the ovaries. This method consists of an incision that is made either vertically or horizontally on your tummy. The way the incision is made is actually very important and is not chosen by chance. Usually, the incision is made horizontally, but in case that there are truly large fibroids or some specific types of cancer, the incision will be made vertically. The whole procedure normally takes up to one hour.
Vaginal hysterectomy is a type of surgery that is used to separate the womb and the cervix. This type of hysterectomy is also very common as it is less invasive than the abdominal hysterectomy. The incision is made in the top of the vagina, through which the surgical instruments are installed and used to remove what it needs to.This type of hysterectomy also takes about an hour to be performed and it does not need general anesthesia, necessarily. This procedure can also be made with local or spinal anesthesia. This means that you will not be asleep during the procedure, as in the case of the general anesthesia. In case of the local anesthesia, you will just not feel any pain, while in the case of the spinal anesthesia, you will just fell your feet and waist numb.

How to prepare for a Hysterectomy?

Before the surgical procedure, you will need to pass undergo an extensive assessment, talk about the benefits and risk of the procedure with your healthcare professional and have different blood tests. These blood tests will present your health status and they are the deciding factor in whether you are fit or not for the hysterectomy.

Hysterectomy side effects

As any other surgical procedures, hysterectomy can also cause some health issues.

Some health complications that can arise after the surgical procedure could be related to the general anesthesia. Though these risks correlated to general anesthesia are low, they could exist. The complications after a general anesthesia might consist of allergic reactions, nerve damage or even death. Death due to general anesthesia occurs in about 1 patient out of 185.000.

Bleeding could be another health complication that is stimulated after getting a hysterectomy. In case of hemorrhage, the patient might need a transfusion.

Also, a hysterectomy could damage the ureter. Usually, in such situations, the ureter is restored during the procedure. The risk is relatively low, as it occurs in about 1% of those who are undergoing a hysterectomy.

Moreover, the hysterectomy can cause some damages to the bladder or the bowel, which could lead to infections or incontinence. Just like in the case of the ureter, the abdominal organs that are affected during a hysterectomy are repaired during the procedure.

Just like in the situation of any other type of surgical procedure, afterwards it exists the risk of developing an infection. These types of infections, are normally easy to treat with antibiotics. After a hysterectomy, you might get a wound infection or a urinary tract infection.

Thrombosis is also a condition that is known to occur after surgeries, especially when the patients are unable to move during longer periods of time. If you encounter thrombosis, or blood clots, as they are also referred to, you might need to get an anticoagulant.

Some of the patients that get a hysterectomy also suffer from vaginal problems post intervention. The healing could be slow and even take up some years.

Furthermore, there have also been registered cases of patients that have encountered ovary failure afterwards surgery. Even if both of the ovaries are left intact during the hysterectomy, the removal of the womb could affect them considerably. The ovaries could fail in the very next years after the surgical intervention, as the womb is no longer one of the blood suppliers.

It is very important to be informed that the removal of the ovaries could induce early menopause. Menopause is stimulated by the end of the ovulation process. In case you are younger than 40 years old, you must think twice before getting a hysterectomy, as during the menopause, the estrogen levels are decreasing. This could represent a high risk of osteoporosis. Other symptoms of early menopause include sweating, disturbed sleep or vaginal dryness.

Moreover, the emotional side effects that one woman can develop after undergoing a hysterectomy could profoundly affect her. There are many patients who are truly sad after the surgical intervention and they feel like they have lost something. This feeling might also be induced by the fact that they are no longer able to make children. Some of these patients have never had a menopause. Other say that they feel less “womanly”. Unfortunately, hysterectomy could also induce depression.

Hysterectomy Recovery

Hysterectomy recovery

Waking up after a hysterectomy might not be the best feeling you get to have. Normally, you would feel some pain and very tired. Each patient is getting painkillers right away, so the discomfort will be highly reduced. Also, if the anesthetic has made you feel sick, you will get the necessary medicine for this, as well.

Normally, in the first day after the procedure, any patient that has suffered a hysterectomy will have bandages over the place of the incision, a perfusion and a catheter. The catheter is usually in for up to about 12 hours. This way, the risk of urinary retention is considerably decreased. Right after removal of the catheter, the urination can be done normally.

Moreover, if the patient had an abdomen hysterectomy, there will be a drainage tube in the abdomen for about one or two days. The purpose of this drainage tube is to absorb the blood underneath the cut. In case the patient has suffered a vaginal hysterectomy, there will be inserted a gauze pack in the vagina. The gauze stops the bleeding and reduces the risks. It is usually kept for only 24 hours.

It is highly important for any patient to try to take even a very short walk in the first day after the hysterectomy has been performed. Doing so, the blood can normally circulate throughout the body and risks of thrombosis, for example, would be considerably decreased.

As soon as the patient is able to move, the physiotherapist will present some basic exercises that have the purpose of improving the mobility. In order to accelerate the recovery process, the physiotherapist will also present pelvic floor muscle exercises.

Though it is important to move a little bit after surgery, it is also very important to comfortably rest, as well, as the muscles and tissues need some time for healing.

The recovery time depends on the type of procedure that the patient got. But, age and the overall level of health influence a lot these times. Therefore, a younger and healthier patient could significantly recover faster than an older patient.

Normally, discharge from the hospital after a vaginal or laparoscopic hysterectomy should be done in 1 or up to 4 days later.

The patients who suffered an abdominal hysterectomy usually discharge in about 5 days after the procedure.

Stiches are normally extracted after 5 to 7 days after the surgical intervention and it is not necessary to visit the hospital for further follow up, only if there are no health complications afterwards.

The full recovery from an abdominal hysterectomy normally lasts between 6 to 8 weeks.

Returning to the normal life after getting a hysterectomy might take some time.

If you have suffered a hysterectomy, you might not be able to return to work very soon. Usually, it takes between 4 to even 8 weeks until you recover, but this only if the job you have is not physical. It is best to return to work just when you truly feel like recovered and able to perform the activities.

After a hysterectomy, you might not be able to drive for about 4-8 weeks, or until you are not disturbed anymore by the seatbelt and you have the power to use the car’s brakes at full capacity. After surgery, it is recommended to talk about driving with the medical specialist before starting to do it.

In terms of exercising, before discharging from the hospital, the staff should give you some recommendations. For example, you should not lift weighty objects, nor gym weights or the groceries. Walking is always a good idea and you would also be able to swim just after the wounds are healed.

The sexual activity should be postponed for about 5 weeks after the hysterectomy. You might get it started once you feel totally able and comfortable to do so. At first, you might encounter some symptoms, such as vaginal dryness or even low libido, but the more time passes after the surgery, the better you will feel.

Though it is not necessarily empirically proven, some would say that hysterectomy would highly impact the sexual response of the nerves. It depends totally on the type of procedure that you have undergone and how the nerves have been affected. But, as some would say, hysterectomy might actually improve considerably your sexual response, therefore the orgasm could be more intense.

Another important aspect of getting a hysterectomy is that you no longer need to take contraceptives, in case that you were doing so before the intervention.

Hysterectomy cost

A hysterectomy might not be covered by the insurance if it is elective. Therefore, the patient might need to pay for the intervention with its own money.

The prices in the United States of America usually vary from 4.200 USD to 8.500 USD. A vaginal hysterectomy is cheaper than a vaginal laparoscopic hysterectomy, for example.

Thanks to medical tourism, the same procedure can be done abroad for less money. Therefore, someone who would travel to get a hysterectomy in a foreign country might actually get a great deal. There are many clinics and hospitals which offer high quality for lower prices.

For example, the prices for hysterectomy in Turkey start from 2.000 USD. In the United Arab Emirates, the cost for hysterectomy is about 3.000 USD. And the list goes on. The quality these clinics provide set the standards.

If you and your medical specialist decide that you need to undergo a hysterectomy, you might want to get it done abroad. As hysterectomy is not necessarily a very difficult surgery, you will recover pretty fast. Therefore, getting the surgical intervention abroad could be actually a great decision, as while you are recovering, you could enjoy the beauty of being a tourist.

Conclusion

Hysterectomy is usually performed when other methods of treatment fail. Though it is a procedure for treating cancer, it can also be used to treat other conditions.

This procedure might affect you both physically and emotionally on short term and the benefits and risks must be discussed with your healthcare professional and ultimately you must consider the advantages long term of performing the intervention. Bear in mind that it will take a couple of weeks before you completely recover after the surgery.